[GalateaDunkel]

Subscribing this thread because I was sectioned for a posterior baby who got stuck in the birth canal after 55 hours labor. I was aware of positioning issues prenatally, but everything I read indicated that it was a question of "optimal" (like the name says) rather than something that could make or break vaginal delivery. So I did work on it quite a bit - but nowhere near as much as I would if I knew what I know now. 95% of my awareness of the issue came from my own research, not from the midwife.

 

[pamamidwife]

Baby turned back to OP soon after my last post. Contx are still 6 to 10 mins apart, very painful in her back. Not close enough to change cervix, so I gave her something to help her sleep better between and maybe slow the contx down.<br><br>
Going home now for awhile. Either it will pick up or we may be going into the hospital...its totally her call and right now, her determination really astounds me.

 

[3daughters]

Thanks for the update, Pam! I'll <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lurk.gif" style="border:0px solid;" title="lurk">: patiently for the next one.

 

[midwifetx]

Pam, although I have never "dialed" a baby's head to turn it (I can't even imagine sticking my fingers inside a baby's sutures, that just seems like asking for trouble)<br><br>
I have been known to put a mom on her chest with her tush in the air and doing (with FULL informed consent) a vaginal exam then pressing evenly on both sides of the baby's head to push it higher so that it can spin to an OA position. This is pretty agressive but I have not had it fail. You have to tell the mom it IS going to hurt, but only for about sixty seconds (it's less painful and more proactive than sterile water blocks because it fixes the problem rather than covering the symptom) It helps if the mom can pull forward on her belly lifting from the pubic bone toward her umbilicus, to help bring the baby up out of the pelvis just a bit so that the baby can spin. I'm not talking about bringing the baby up high enough that there is a possibility of cord prolapse, just enough so that they're not 'stuck.' If you decide to do it, make sure that as you are doing it, make sure you keep the pressure on the baby's head even and constant until you feel the baby spin. You will notice a sense of relief from the baby in your own spirit when they settle into the OA position as well as from the mom, who will say it was a very painful experience but definately made the labor work better and hurt less during contractions.<br><br>
{{Putting on my flame-proof panties now}}

 

[Reha]

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<div>Originally Posted by <strong>midwifetx</strong></div>
<div style="font-style:italic;"><br>
I have been known to put a mom on her chest with her tush in the air and doing (with FULL informed consent) a vaginal exam then pressing evenly on both sides of the baby's head to push it higher so that it can spin to an OA position. This is pretty agressive but I have not had it fail. You have to tell the mom it IS going to hurt, but only for about sixty seconds (it's less painful and more proactive than sterile water blocks because it fixes the problem rather than covering the symptom) It helps if the mom can pull forward on her belly lifting from the pubic bone toward her umbilicus, to help bring the baby up out of the pelvis just a bit so that the baby can spin. I'm not talking about bringing the baby up high enough that there is a possibility of cord prolapse, just enough so that they're not 'stuck.' If you decide to do it, make sure that as you are doing it, make sure you keep the pressure on the baby's head even and constant until you feel the baby spin. You will notice a sense of relief from the baby in your own spirit when they settle into the OA position as well as from the mom, who will say it was a very painful experience but definately made the labor work better and hurt less during contractions.<br><br>
{{Putting on my flame-proof panties now}}</div>
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Thanks for sharing this Allison! WHile it is rather "interventive", the way that I see it is that it is another option to try before transporting (which often will mean a c-sect, esp where we live where there is no hospital VBAC!)...and a c-sect is WAY more interventive than that. So, I think that when it comes down to the end and it is either transport or try something like this, I would be willing to give it a try (with mom fully consenting, of course!!)<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink">

 

[Defenestrator]

One trick that my friend Lee taught me (worked at one of my births, too) which can be done if mom is laboring standing -- have her stand in a doorway with a wide stance and her back touching the other side of the doorjamb and push hard against the doorjamb, pressing her back into the opposite side. It is a way for mom to get counterpressure on her back and also the baby does not like the pressure and will often turn away from it.<br><br>
The other thing, homeopathically, which has worked for me is Aconite 200c. I usually only give it when Pulsatilla 200c has been ineffective, but it seems to work when pulsatilla does not.<br><br>
I am hoping and praying for your client. Sometimes pressing the reset button by getting some rest can make a major difference. I hope you are able to help her.<br><br>
Take care,<br><br>
Stacia

 

[pamamidwife]

Oh, Stacia, the Aconite is a good reminder. She obviously is really afraid - of the pain, the pain getting worse, transporting, etc. It's such a good remedy. Thanks. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
Allison, you won't get any flames from me! Yesterday I had her in knee-chest and actually pushed the baby out very easily from her pelvis. I kept my fingers against the baby's head and could feel baby moving alot. At this point, it was too high for me to tell position but I maintained the pressure for at least a couple minutes. Then I had her roll to her side and do some side belly lifts. I think we can definitely try again - it didn't hurt her at all when I did it. I have this overwhelming urge to put my whole hand in there and just turn the baby like I've seen in so many old obstetrical text books. It looks so easy! Then again, I have a VBAC and I have to keep that in mind.<br><br>
We've done belly lifts, too. Haven't tried the sterile water injections yet - she's afraid of needles, but I think that the pain might be at that point to overcome the concern. The alternative needle is too much to think about. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
She slept some this morning, though it was hard to get to sleep. Lennon and I are going back over there around noon - I will suggest a shower, washing her hair (it seems to change outlook so much), then we can work on the suggestions here. I think we'll talk alot about fear and the big concern about more pain. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"><br><br>
Any other suggestions are welcome!

 

[midwifetx]

ITA about washing their hair. If they wear make up I always suggest putting that on as well.

 

[Triciabn]

Not a midwife.. but last time I had an OP baby and was in labor for 36hours of labor and was stuck in transition for 10 of those hours.<br>
I am really trying to go the best I can to make sure that I am postioned correctly to postion the baby. My question is that I have read that multiparas only need to pay close attention in the last two weeks (now what those *last two weeks* are .. is a question in itself) and first timers need to pay attention in the last 4weeks. Is that true?<br>
Now the other question is about the knees below the hips when sitting... I am really confused about that... are we talking about 90* angles (back to hips and knees to lower legs)?<br>
Is there any easier things that I could pay attention to... and/or is there an easier way to explain the knees lower then hips stuff?<br>
And I think the only way a pregnant woman can get the importance of this stuff.... is by not doing it and having to endure the consequences... at least it was in my life. I only half heartedly attempted to sit correctly with my last one. Now that I am 33 weeks pregnant.. I am really trying to do the right thing.<br>
Tricia

 

[GalateaDunkel]

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<div>Originally Posted by <strong>Triciabn</strong></div>
<div style="font-style:italic;">And I think the only way a pregnant woman can get the importance of this stuff.... is by not doing it and having to endure the consequences...</div>
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Well, I think it would help a lot if there was more candor about the fact that it can lead to hellish pain and even c-sections. Unfortunately, this is somewhat in tension with the natural birth community's official party line (so to speak), which says that c-sections for progress/presentation issues are always bogus, and that painful or abnormal labors are always the result of hospital-style intervention.

 

[3daughters]

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<div>Originally Posted by <strong>GalateaDunkel</strong></div>
<div style="font-style:italic;">Well, I think it would help a lot if there was more candor about the fact that it can lead to hellish pain and even c-sections. Unfortunately, this is somewhat in tension with the natural birth community's official party line (so to speak), which says that c-sections for progress/presentation issues are always bogus, and that painful or abnormal labors are always the result of hospital-style intervention.</div>
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Two questions arise from your statement:<br><br>
1) What about our lifestyle is causing all these malpositioned babies?<br>
2) Shouldn't EVERY midwife and/or counsel her clients on OFP to try and avoid malpositioned babies BEFORE labor?<br><br>
I ask because my friend had a c/s. First baby, she labored with a midwife, unmedicated until 10 cm. The only intervention (one may have been too much) was AROM. Baby was definitely posterior possibly due to anterior placenta. Babies heartrate had too many decels and the midwife got nervous and called in her backup OB. After surgery he said babies head was positioned in such a way that "it was like trying to put a square peg in a round hole". I can speculate forever on what caused the c/s and whether or not it was 'necessary' but this thread really has me thinking. I'm still training and this was one of my earlier births. Maybe I could have counseled her on OFP and maybe her midwife should have...maybe baby wouldn't have settled properly due to the location of her placenta....<br><br>
I would love if someone would put together a 'cheat sheet' of ways to turn a baby into optimal position before and during labor.

 

[midwifetx]

Bucket seats. Really, I think they are EVIL. We have bucket seats in front of computers, easy chairs in our living rooms and bucket seats in our cars. They are all comfy cushy but have us sitting on our sacrums instead of the ishium <a href="http://biology.clc.uc.edu/graphics/bio105/pelvis.jpg" target="_blank">http://biology.clc.uc.edu/graphics/bio105/pelvis.jpg</a> as we are meant to. We have cruddy body mechanics. All those years of mama and grandma saying "Sit up! Don't slouch!" were not just to bother us, they were good advice! I don't know how many mothers I have discussed this with, and they say "Sitting 'right' is uncomfortable" Well, waah.<br><br>
{stepping down from soapbox} anyhow, that's my diatribe on proper posture and the consequences of 'comfort'<br><br><a href="http://www.spinningbabies.com" target="_blank">www.spinningbabies.com</a> has all the 'cheat sheet' advice you could ever need!<br><br>
For me, though, the advice is as follows<br><br>
1.Sit up! Don't slouch!<br>
2.Move your body regularly! make love, exercise, dance, walk<br>
3.Put a small pillow in the seat of your car under your bottom so that you can have better posture.<br>
4.Get out of the computer chair/lazy boy (use an exercise/birthball instead!)<br>
5.Use good body mechanics when going about daily tasks (lift with knees and butt not with your back)<br><br>
edit to fix spelling

 

[Jane]

My preceptor swears that lunging can help babies turn, by opening the pelvis in a new angle. She has them put one foot up on a stool or the bath tub edge and lunge down until that up-knee is fully bent, with mom having her hands on someone's shoulders, someone who is also lunging. She has them do it only during contractions for 30 minute intervals, 4 contractions one way and 4 contractions the other leg. I've seen it work well for multips who are "stuck" at a certain contraction pattern for a while, waiting for the baby to turn before desending. I don't do lots of VE, so I often suggest it as a last resort after several hours of those characteristic one hard, one soft, slightly irregular contractions.<br>
Next time I think I'll try doing that with mom in L lateral, but putting her up-foot on my leg and having her push down during contractions.<br><br>
Sometimes full relaxation seems to do wonders (ie, the epidural after transfering for maternal request/exhausting). I wonder sometimes about Adivan, which some CNMs are sending women home with for prodomal labors and instructions to sleep.

 

[Spark]

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<div>Originally Posted by <strong>pamamidwife</strong></div>
<div style="font-style:italic;">I've decided that I will not transfer again for a posterior baby with a primip. I'm working harder to really figure out how to help women and babies BEFORE we get to labor. I don't really want that fear in my life - it's not worth it. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"></div>
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Just a gal, not a doula or MW. But, THANK YOU! Thank you so much for saying that, Pam! With my first he was posterior with a compound presentation. My HB MW stuck with me. It was a stop start kind of labor with some reverse dilation, but she helped me feel like all was A-OK. My baby never did turn, I ended up pushing him out posterior with his hand up on his head.<br><br>
To choose HB with your first is taking a leap of faith. To have been transported because my labor wasn't progressing as it should, would have damaged my spirit. I don't know if I would have gone on to have my other babies at home.<br><br>
Oh, and I TOTALLY believe in OFP. Oh, man from 32 weeks on, I sit on a birth ball, never recline & float belly down. I'm like neurotic about it. I didn't do much of that with my first though!

 

[pamamidwife]

Well, I had a craniosacral therapist come over and she did an hours worth of bodywork. Three hours later, it was obvious the contractions felt different. Still, they needed to be closer together to really dilate the cervix.<br><br>
Mom was hesitant to try thing to increase the contx....of course, it means more pain. We had a big talk about what she wants and what she is afraid of...she talked privately with her dh and decided to get things moving. She took a shower first...<br><br>
It was the decision to move forward that opened things. She is now having contx every 4 mins or so. Her back still hurts, but its obvious its just residual.<br><br>
So, yay for patience! Still keep us in your thoughts!

 

[channelofpeace]

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<div>Originally Posted by <strong>midwifetx</strong></div>
<div style="font-style:italic;">Bucket seats. Really, I think they are EVIL. We have bucket seats in front of computers, easy chairs in our living rooms and bucket seats in our cars. They are all comfy cushy but have us sitting on our sacrums instead of the ishium <a href="http://biology.clc.uc.edu/graphics/bio105/pelvis.jpg" target="_blank">http://biology.clc.uc.edu/graphics/bio105/pelvis.jpg</a> as we are meant to. We have cruddy body mechanics. All those years of mama and grandma saying "Sit up! Don't slouch!" were not just to bother us, they were good advice! I don't know how many mothers I have discussed this with, and they say "Sitting 'right' is uncomfortable" Well, waah.<br><br>
{stepping down from soapbox} anyhow, that's my diatribe on proper posture and the consequences of 'comfort'<br><br><a href="http://www.spinningbabies.com" target="_blank">www.spinningbabies.com</a> has all the 'cheat sheet' advice you could ever need!<br><br>
For me, though, the advice is as follows<br><br>
1.Sit up! Don't slouch!<br>
2.Move your body regularly! make love, exercise, dance, walk<br>
3.Put a small pillow in the seat of your car under your bottom so that you can have better posture.<br>
4.Get out of the computer chair/lazy boy (use an exercise/birthball instead!)<br>
5.Use good body mechanics when going about daily tasks (lift with knees and butt not with your back)<br><br>
edit to fix spelling</div>
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Ahhhhh, if it were only that easy...<br><br>
Not that some, or the majority of cases aren't caused by poor body mechanics, but it is soooo easy to just dismiss the baby's part in the whole thing. I have had two malpositioned babies (one breech from about 30 wks on and one posterior from 30 wks on) and i did everything right. For whatever reason-- cord positioning, placenta positioning, my child's personal preference for an alternate position, they weren't going to be like the other babies. Some babies just choose an alternate position than what might be optimal and there isn't a darn thing that is going to get them to move.... believe me, i have tried.

 

[pamamidwife]

After baby moved back to posterior again, mom chose to transport. So we are prepping for a cesarean.<br><br>
Three days of working hard...she's done amazing work!

 

[midwifetx]

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I believe you. Sometimes there is nothing that can be done (3-6% of the time!) and you just have to go with what you've got. Sometimes it is about the baby, and some women's pelves (yes, that is the actual plural of pelvis...wierd.) are shaped in a way that encourages odd presentations. I know more than one woman who had birthed EVERY single one of her babies OP, and that's just the way she is built.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Three days of working hard...she's done amazing work!</td>
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You too! (((pam))) It's never easy, but sometimes it is right. Maybe they will give her a few hours after the epidural and she'll labor through to birth vaginally. I've seen it happen more than once, as Apricot has said.

 

[MsElle07]

How did the birth go, Pam? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> I read this thread with interest.

 

[mandib50]

any news pam?